This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (22) Citing Articles via Google Scholar Google Scholar Articles by Wiesbauer, F. Articles by Schillinger, M. Search for Related Content PubMed PubMed Citation Articles by Wiesbauer, F. Articles by Schillinger, M. Related Collections Cardiovascular Outcomes Pharmacology

---

CARDIOVASCULAR ANESTHESIA

Perioperative ß-Blockers for Preventing Surgery-Related Mortality and Morbidity: A Systematic Review and Meta-Analysis

From the Departments of *Cardiology, Emergency Medicine, Angiology, and University Library, Vienna General Hospital, Medical University, Vienna, Austria.

Address correspondence and reprint requests to Franz Wiesbauer, MD, MPH, Department of Internal Medicine II, Cardiology Unit, Vienna General Hospital, Medical University, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to franz.wiesbauer{at}meduniwien.ac.at.

BACKGROUND: Perioperative ß-blockers are suggested to reduce cardiovascular mortality, myocardial–ischemia/infarction, and supraventricular arrhythmias after surgery. We reviewed the evidence regarding the effectiveness of perioperative ß-blockers for improving patient outcomes after cardiac and noncardiac surgery.

METHODS: Eleven large databases were searched from the time of their inception until October 2005. Various online-resources were consulted for the identification of unpublished trials and conference abstracts. We included randomized, controlled trials comparing perioperative ß-blockers with either placebo or the standard-of-care. Of the 3680 retrieved titles, 69 met inclusion criteria for analysis. Odds ratios (OR) assuming random effects were computed in the absence of significant clinical heterogeneity.

RESULTS: ß-Blockers reduced the frequency of ventricular tachyarrhythmias [OR (cardiac surgery): 0.28, 95% CI 0.13–0.57; OR (noncardiac surgery): 0.56, 95% CI 0.21–1.45], atrial fibrillation/flutter [OR (cardiac surgery): 0.37, 95% CI 0.28–0.48], other supraventricular arrhythmias [OR (cardiac surgery): 0.25, 95% CI 0.18–0.35; OR (noncardiac surgery): 0.43, 95% CI 0.14–1.37], and myocardial ischemia [OR (cardiac surgery): 0.49, 95% CI 0.17–1.4; OR (noncardiac surgery): 0.38, 95% CI 0.21–0.69]. Length of hospitalization was not reduced [weighted mean difference (cardiac surgery): –0.35 days, 95% CI –0.77–0.07; weighted mean difference (noncardiac surgery): –5.59 days, 95% CI –12.22–1.04] and, in contrast to previous reports, ß-blockers did not reduce mortality [OR (cardiac surgery): 0.55, 95% CI 0.17–1.83; OR (noncardiac surgery): 0.78, 95% CI 0.33–1.87], and they had no influence on the occurrence of perioperative myocardial infarction [OR (cardiac surgery): 0.89, 95% CI 0.53–1.5; OR (noncardiac surgery): 0.59; 0.25–1.39].

CONCLUSIONS: ß-Blockers reduced perioperative arrhythmias and myocardial ischemia, but they had no effect on myocardial infarction, mortality, or length of hospitalization.

This article has been cited by other articles:

				American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine, Society for Vascular Surgery, L. A. Fleisher, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery J. Am. Coll. Cardiol., November 24, 2009; 54(22): e13 - e118. [Full Text] [PDF]

				American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine, Society for Vascular Surgery, K. E. Fleischmann, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade J. Am. Coll. Cardiol., November 24, 2009; 54(22): 2102 - 2128. [Full Text] [PDF]

				Authors/Task Force Members, D. Poldermans, J. J. Bax, E. Boersma, S. De Hert, E. Eeckhout, G. Fowkes, B. Gorenek, M. G. Hennerici, B. Iung, et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA) Eur. Heart J., November 2, 2009; 30(22): 2769 - 2812. [Full Text] [PDF]

				G. Landesberg, W. S. Beattie, M. Mosseri, A. S. Jaffe, and J. S. Alpert Perioperative Myocardial Infarction Circulation, June 9, 2009; 119(22): 2936 - 2944. [Full Text] [PDF]

				J. W. Sear, J. W. Giles, G. Howard-Alpe, and P. Foex Perioperative beta-blockade, 2008: What does POISE tell us, and was our earlier caution justified? Br. J. Anaesth., August 1, 2008; 101(2): 135 - 138. [Full Text] [PDF]

				T. Kurita, K. Takata, K. Morita, and S. Sato Lipophilic {beta}-adrenoceptor antagonist propranolol increases the hypnotic and anti-nociceptive effects of isoflurane in a swine model Br. J. Anaesth., June 1, 2008; 100(6): 841 - 845. [Abstract] [Full Text] [PDF]

				W. S. Beattie, D. N. Wijeysundera, K. Karkouti, S. McCluskey, and G. Tait Does Tight Heart Rate Control Improve Beta-Blocker Efficacy? An Updated Analysis of the Noncardiac Surgical Randomized Trials Anesth. Analg., April 1, 2008; 106(4): 1039 - 1048. [Abstract] [Full Text] [PDF]

				B. M. Biccard, J. W. Sear, and P. Foex Meta-analysis of the effect of heart rate achieved by perioperative beta-adrenergic blockade on cardiovascular outcomes Br. J. Anaesth., January 1, 2008; 100(1): 23 - 28. [Abstract] [Full Text] [PDF]

				L. A. Fleisher Perioperative {beta}-Blockade: How Best to Translate Evidence into Practice Anesth. Analg., January 1, 2007; 104(1): 1 - 3. [Full Text] [PDF]